Why Does My Patient with Lung Cancer Keep Smoking?


What does it mean to have blinding ignorance? Isn’t ignorance just ignorance? Why does Leo add on blinding?  Was it because something so clear to him was completely misunderstood or purposely ignored by his peers and people of his day?  Sigmund Freud once said that Leo was like a man who awoke too early in the darkness, while the others were all still asleep.


If you think about something that is blinding, what do you picture?  My first thought is coming out of a dark movie theater on a beautiful sunny day.  I’m squinting like a mole ’til my pupils adjust and I can focus.

Are you like da Vinci, awake while others are sleep walking? Or are you one whose eyes are shut? How do we know which camp we fall into? To be misled is one thing, but to be misled by our own blinding ignorance is indeed a wretched condition.

I recently saw a patient who was diagnosed nine months ago with lung cancer.  Stage 3 with mets to the brain. A smoker?  You bet, for over 40 years.  She’s gone through chemo, and now faces radiation to the brain.  Has she stopped smoking? Nope.  I asked her why she hasn’t quit.  Her reply:

I’ve cut way down.  I’m going through a lot, and smoking helps me deal with it.  I know I need to quit.  I’m working on it.

I encouraged her, and remarked that I was proud of her progress. Yet I couldn’t quite wrap my mind around continuing with a behavior that is killing you.  A strange thought coming from a person like me who works in addiction medicine.

I would expect a woman who has a potential of 30 years left might consider lung cancer a wake up call and quit smoking. Does she have blinding ignorance?

How do I help her? Can she be helped?

How do we wretched mortals get our eyes open?

You never give up. Try another approach, don’t preach, lecture, yell or use over the top scare tactics. Habits are hard to break.  Addiction is a tough disease, ignorance is too. Fall down twenty times, get up sixty.  No matter what, never write someone off as too far gone.  Where there is breath and movement,  there is life.  Where there is life, there is hope. Blinding conditions are temporary.  Sooner or later, the eyes adjust and can see.


What are your thoughts?